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Dealing with Childhood TraumaSAMA Conference
23 October 2016(30’)
Sebastian van As
Head: Trauma Unit Red Cross War Memorial Children’s Hospital
Chair: Childsafe South Africa
Overview
1. Background
2. Red Cross Children’s Hospital
3. Modern Imaging
4. Violence against children
5. Child Safety Promotion
TRAUMA
*5 Million trauma deaths per year
*Today 16 000 deaths
or about 50 Boeings
*Trauma leading cause childhood deaths
*Approximately 1 million deaths annually*Motor vehicle crashes
* Drowning
* Burns
0
1000
2000
3000
4000
Firear
m
Sharp
MVA
ped
MVA
uns
Blu
nt
Burn
Uns
MVA
pas
MVA
driv
Han
ging
Dro
wni
ng
Poison
Rai
lway
Stran
gleBik
e
Mortality 10 times as
a result of
unintentional injuries
Morbidity 25 times
more likely to be
admitted to hospital
Child Injuries
FALLS
DROWNING
TRAFFIC
PHYSICAL VIOLENCE
SEXUAL VIOLENCE
EMOTIONAL VIOLENCE
NEGLECT
POISONING
BURNS
"ACCIDENTAL" "NON-ACCIDENTAL"
Child
Disability
Child Deaths
*Most commonly initially performed special investigations in
hospitals are X-rays
*Lodox® derived from De Beers
*X-ray device to curb raw diamond theft
*Diamond scanner very successful
*Development rather expensive
*Other uses: As a diagnostic imaging device in trauma units
*Groote Schuur 1999
*Millpark 2002
*Baltimore Trauma Centre
*Radiation
0
10
20
30
40
50
Ambulan
t
Stretc
her
Resusci
tation
Lodox Xray
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
Skull
Spine
Extre
mityChe
st
Abdom
enPe
lvis
Time
2 Years analysed
*All polytraumas
*All hemodnamically/respiratory unstable
*All Motor Vehicle Crashes victims
*All gunshots
Lodox is a great screening tool in Trauma
• It is child-friendly• It saves time• It picks up clinically missed fractures• It images with far less radiation• It is life-saving in dire emergencies
• And it’s sexy!
Conclusion
*11 Month Infant
*Stabbed by father (trying to attack his
mother) in the shoulder
*Sutured at Day Hospital
*Cried when moving left arm
*Decided to do a XR
*Very high levels of violence in South Africa
*High level of Alcohol abuse
*High murder rate 39/100 000
*Reported Rape 55 000/year
*(But in the UK 50 000/year!)
*Reported Child abuse 25 000/year
Presently still many of our products
manufactured by young children
(usually low and middle income countries)
but out of our direct sight……
*Red Cross Children’s Hospital Cape Town
*Childsafe since 1978
*CREATING A SAFER WORLD FOR CHILDREN
*Large database (document all injuries)
*10 000 children annually (15 years)
*150 000 injuries documented
*Child Accident Prevention Foundation of Southern Africa (CAPFSA) since 1978
*Started by Professor Cywes
Head of Pediatric Surgery:
*Accidents an important cause of child admissions to hospital
*To reduce intentional (violence) and unintentional
injuries (accidents) of all severity through:
*Research
*Education
*Environmental change
*Recommendations for legislation
*Before you develop strategy, you have to
know what is going on!
*We maintain childhood surveillance system
*Largest single-centre one in the world
*Annual National Child Accident Prevention Month
*Established National Child Safety Centre 2014
*Courses for Day Care workers on child safety
*Newsletter: the Childsafe REPORTER (quarterly)
*Community based child safety educational programs
at schools
*Safe Travel to School Pogramme
*Installation of “Tracker “ to
monitor school bus (taxi) drivers
*Cash incentives for best drivers
*Once a year – MINIBUS PRIZE
*Currently 400 drivers employed
*Driving improving during programme
*Driving safer than the general public
*Legislation regarding the manufacturing of SA Bureau
of Standards approved child restraints for the use in
motor vehicles
*Motivated for regulations on children’s furniture
*ChildSafe presented a child friendly submission to
parliament in support of the New Firearms bill